Quality healthcare delivery encompasses the provision of effective/efficient patient care services based on current clinical guidelines or evidence. The ultimate goal is to promote patient outcomes and experience. Hospital continuous quality improvement (CQI) initiatives could improve patient safety, patient-provider communication, and pain management, among others to bolster inpatient satisfaction scores. Further, at organizational the level, effective clinical governance is required to mitigate risks, promote best clinical practices, maintain a skilled workforce to drive the quality initiatives, manage sentinel events, and promote patient/family involvement.
Purpose of Quality Management Policy
A quality management policy provides a framework for “visualizing, structuring, and standardizing” clinical operations and work processes (Munechika, Sano, Jin, & Kajihara, 2014, p. 892). These include clinical goals, staff roles and responsibilities, and quality standards. Standardization provides a means of exchanging best clinical practices. A quality-centered system based on the Total Quality Management (TQM) framework has been shown to create a culture of safety through reduced medication errors, better patient satisfaction, and improved care transition (Munechika et al., 2014).
Necessity of Quality Management Policy
The complex, interdependent nature of hospital systems makes a systems approach to quality management a necessity. A quality management policy/system is necessary to manage processes and resources to achieve the desired clinical outcomes across the departments. Hospital departments are resourced with multi-disciplinary teams whose performance is difficult to measure without a cross-functional management policy to measure patient safety and satisfaction. Thus, management by policy is required to improve quality in healthcare.
The main healthcare stakeholders include patients, families, practitioners, hospital managers, policy makers, accreditation team, and third party payers. The definition of quality healthcare differs between stakeholders due to varied perceptions, needs, and expectations. For patients, quality care must meet individual needs and expectations (Mosadeghrad, 2013). In contrast, patient family would consider patient satisfaction a quality metric.
Quality, from a healthcare profession’s view, entails adherence to clinical guidelines and standards (Mosadeghrad, 2013). Managers and policy makers would consider practitioner and patient satisfaction levels an indicator of quality. In contrast, for payers and accreditation team, quality care is one that is cost-effective and conforms to quality standards, respectively. However, patient satisfaction is considered a quality metric by all stakeholder groups.
Manufacturing/service quality resembles healthcare quality in many ways. First, for both, the key performance indicator (KPI) is customer/patient satisfaction. Quality improvement tools, including TQM and the lean methodology, focus on customer/patient experience as a quality metric (Dahlgaard, Pettersen, & Dahlgaard-Park, 2012). Secondly, quality in manufacturing and healthcare involves standards and standardization of process factors.
Manufacturing and clinical workflows follow standard procedures/best practices. Third, technology utilization in both sectors helps achieve the desired efficiency or costs. For hospitals, the HITECH act provides for incentive payments for compliance with meaningful use specifications (Dahlgaard et al., 2012). Fourth, quality in both cases is achieved through protocols and in-house and external quality management systems to monitor progress.
In both manufacturing quality and healthcare quality, cultural change is a prerequisite. According to Dahlgaard et al. (2012), successful TQM and lean production efforts in healthcare or manufacturing requires a change in “systemic factors” such as leadership to create a quality-oriented organizational culture (p. 674). Hospitals and manufacturers leverage on staff competencies to achieve quality objectives. They align employee training with the set quality goals. Sound management is required to support a cultural change through frameworks such as PDCA, i.e., planning, doing, checking, and acting (corrective action).
Routine Monitoring of Quality
Patient satisfaction is a crucial indicator of healthcare quality. Patient-centered care improves patient outcomes through treatment planning and respect for patient autonomy or choice. Further, inpatient experience and safety can be improved through better nurse-patient communication to reduce sentinel events or the medical error risk. Monitoring the 30-day readmission rates and post-discharge ER visits for patients with chronic conditions such as diabetes can indicate the success of the current nursing quality initiatives. In addition, nurse engagement through training and development can reduce turnover (Bulkapuram, Wundavalli, Avula, & Reddy, 2015). In this way, the hospital will retain skilled nurses to drive its quality efforts.
Accrediting & Regulatory Organizations
Hospital accreditation schemes provide means of improving healthcare quality. Often, the quality indicators are tied to financial incentives. The Joint Commission on Accreditation of Healthcare Organization (JCAHO) is a federal body that determines participating hospitals and eligibility for CMS incentive programs (Hinchcliff et al., 2012). Other accreditation and regulatory organizations in the US include NCQA, AAHC, and AHRQ, among others.
Roles of Accrediting/Regulatory Organizations
Healthcare accreditation and regulatory organizations develop accreditation standards through a consensus-oriented approach involving clients, hospitals, and clinical staff (nurses and physicians), among others (Hinchcliff et al., 2012). For example, the CMS developed 11 HCAHPS measures for comparing hospital performance to state and national averages. Accreditation/regulatory bodies also support performance tracking through continuous quality improvement (CQI) initiatives at the hospital level. Insurance coverage and CMS incentive payments are tied to quality indicators.
Providers meeting the specified scores on these indicators receive incentive payments under the value-based purchasing (VBP) system. Additionally, regulatory agencies such as CMS provide performance data for patients to compare and select a hospital based on its quality ranking (Hospital Compare website). Their focus on quality and patient safety aims to achieve efficiency and reduce healthcare spending.
The key healthcare quality indicators are clinical efficiency and patient experience or satisfaction. Having a quality management policy enables a hospital to standardize its processes and clinical resources to achieve its quality objectives. Healthcare stakeholders interpret quality differently due to varied expectations and needs. In both manufacturing and healthcare sectors, patient/customer satisfaction level is a key quality metric. Accreditation bodies promote healthcare quality by developing standards and measures for identified quality domains.
Bulkapuram, S., Wundavalli, L., Avula, K., & Reddy, K. (2015). Employee engagement and its relation to hospital performance in a tertiary care teaching hospital. Journal of Hospital Administration, 4(1), 48- 57.
Dahlgaard, J., Pettersen, J., & Dahlgaard-Park, S. (2012). Quality and lean health care: A system for assessing and improving the health of healthcare organizations. Total Quality Management, 22(6), 673- 689.
Hinchcliff, R., Greenfield, D., Moldovan, M., Westbrook, J., Pawsey, M., Mumford, V., & Braithwaite, J. (2012). Narrative synthesis of health service accreditation literature. BMJ Quality and Safety, 21(12), 979- 991.
Mosadeghrad, M. (2013). Healthcare service quality: Towards a broad definition. International Journal of Health Care Quality Assurance, 26(3), 203-221.
Munechika, M., Sano, M., Jin, H., & Kajihara, C. (2014). Quality management system for health care and its effectiveness. Total Quality Management, 25(8), 889-896.